Monday, March 18, 2013

This article originally appeared on the University of Miami's Miller School of Medicine website on March 15, 2013 and contributed to the Witness for Peace blog by Dyani Loo, one of the founders of the initiative.

Four MillerSchool students have
launched a grassroots campaign aimed at convincing state lawmakers to allow the
transfer of clean needles and syringes to people who inject illegal drugs, an
infection-control practice authorized in 35 other states but illegal in Florida.

The Florida Needle Exchange
Initiative was inspired by a study Hansel Tookes, now a third-year MillerSchool student,
published in 2011 that found eight times the number of publicly discarded
needles on the streets of Miami as on the
streets of San Francisco, a city with
twice the estimated number of injection drug users.

Unlike Miami, San
Francisco provides injection drug users the opportunity to
exchange their used syringes for sterile ones. Tookes and his initiative
co-founders have presented such compelling evidence that needle exchange
programs reduce the risk of acquiring or transmitting HIV, hepatitis B and C,
and other blood-borne infections that two lawmakers have introduced bills to
legalize them in Florida.

Now, under the guidance of José Szapocznik, Ph.D., professor and chair
of epidemiology, Tookes and his initiative co-founders, fourth-year students
Marek Hirsch and Dyani Loo, and Chanelle Diaz, a second-year M.D./M.P.H.
student, are going public with their campaign to pass House Bill 735, sponsored
by state Rep. Mark S. Pafford of West Palm Beach, or Senate Bill 808, sponsored
by Senator Gwen Margolis of Miami.

Joined by the Miller School’s chapter of the Student National Medical
Association (SNMA), they are encouraging supporters to follow the progress of
both measures on The Florida Needle Exchange Initiative website and call and
write their legislators, and the chairs of the subcommittees to which the bills
are assigned, to urge passage. Templates for two letters, one for members of
the House and the other
for members of the Senate, offer
another compelling reason fiscally conscious lawmakers should embrace syringe
exchanges: Such programs not only save lives, they save taxpayer money.

“The estimated lifetime cost of treating an HIV positive person is over
$600,000—with Medicaid/Ryan White footing the bill for those that cannot afford
it,” the letters state. “The cost of treating hepatitis C is even greater:
hepatitis C is responsible for one third of all liver transplants that cost
$280,000 for just one year alone. A clean syringe can cost as little as 97
cents.”

But even that negligible cost, the letters note, would unlikely be borne
by the state because syringe exchange programs “are commonly funded by
non-profit organizations, private donations and local municipalities.”

In urging SNMA members to join the battle, Jennifer McLeod, the SNMA
chapter’s Vice President and Community Service Chair, also notes that injection
drug users and their sexual partners are not the only people at increased risk
of infection from dirty or discarded syringes. Anyone who comes upon one is,
and in many of Miami’s poorest
neighborhoods, that could mean many children.

“In his study, Hansel found needles in many public areas, including
parks, streets and sidewalks,” McLeod said. “So this is a very important public
health concern and our chapter has a unique opportunity to influence public
policy and safeguard many unwitting Floridians.”

Published in the journal Drug and Alcohol Dependence in December
2011, Tookes’ study, “A comparison of syringe disposal practices among
injection drug users in a city with versus a city without needle and syringe
programs,” already has galvanized widespread support for changing Florida’s
paraphernalia law, which specifically prohibits the exchange of syringes, from
a diverse group of public health and medical organizations.

In their biggest coup, Tookes and Hirsch convinced the Florida Medical
Association (FMA) last year to seek the legislation legalizing syringe exchange
programs. Initially, members of the FMA’s Board of Governors were reticent, but
thanks to reports presented by Diaz, UM’s FMA medical student delegate, the
FMA’s House of Delegates adopted a resolution supporting the amendment to Florida law.

Since then, more science-backed lobbying by the students under the
auspices of the Florida Needle Exchange Initiative has produced a groundswell
of support from other organizations, including the Florida Osteopathic Medical
Association, the medical societies in Miami-Dade, Palm Beach, Lee, and
Hillsborough counties, the Florida Nurse Practitioner Network, the Florida
Chapter of the American Academy of Pediatrics, and the Florida Academy of
Family Physicians.

Tookes, who undertook the syringe study as an M.P.H. student, is
heartened by the support, and the prospects for change.

“I hope that the Legislature will allow Florida to join 35
other states in this evidence-based practice and take meaningful steps in the
fight against HIV in our state,” he said. “As a medical student, I have seen
first-hand the consequences of our lack of syringe exchange programs in Florida and I’m
hopeful our research and legislation translate into new health policy that
leads to improved health outcomes for people in Miami living at the
center of both an infectious disease and drug abuse epidemic.”

For his study, Tookes replicated the methods of a 2008 study conducted
in San Francisco by enlisting
fellow students and epidemiology and public health staff to visually inspect
the top quartile of Miami neighborhoods
with the highest concentration of drug use, as designated by city data. Walking
those neighborhoods, they found over 300 dirty syringes, more than eight times
as many as on the streets of San
Francisco.

The study—the first to compare a city with a needle exchange program to
one without—also revealed that 95 percent of syringes used by injection drug
users in Miami were disposed of improperly, versus only 13 percent in San
Francisco. That translated to nearly 10,000 needles and syringes per month cast
aside in trashcans, sewers, parks and other public places.

For more information on the campaign to change the law, visit The
Florida Needle Exchange Initiative’s website, or its Facebook page.

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